Stamford Bridge Beaumont

Stamford Bridge Beaumont is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 107 people across five separate areas, during this inspection 55 people were living at the service.

A new registered manager had applied to register with the Care Quality Commission (CQC) since our last inspection and their application had been accepted on 3 August 2018. They had worked for Barchester Healthcare Homes Limited for eleven years, some of which were spent managing and overseeing other Barchester run homes in the East Riding of Yorkshire. The registered manager had previously supported Stamford Bridge Beaumont and they were knowledgeable in terms of the current issues, work underway and plans to maintain sustained improvements across the service.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in April 2018 we found the provider to be in breach of seven of the Health and Social Care Act 2008 (Regulated Activities) 2014 in Regulation 9 Person centred care, Regulation 10 Dignity and Respect, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 17 Good governance and Regulation 18 Staffing.

We also identified one breach of the Care Quality Commission Registration Regulations 2009. This related to the failure to notify us of other events and incidents which had occurred at the service as the law requires.

The service was rated Requires improvement. The provider continued to complete an action plan to show what they would do and by when to improve the key questions Safe to at least requires improvement.

We found during this inspection that the provider had made significant improvements, which achieved compliance to meet the requirements of Regulations 9, 10, 11, 12, 13, 17 and 18.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this inspection we rated the service Good. Although some areas of guidance and documentation needed embedding into day to day staff practice, overall there had been significant progress and improvement made throughout the service.

Management of medicines had improved since our last inspection. However, some areas of guidance and documentation required further attention. The impact to people was low as these were recording issues rather than errors in administration of medicines.

Quality assurance systems and audits identified where improvements needed to be made and noted good practice throughout the service so this could be communicated and celebrated with staff. However, some medicines audits required more detail to confirm which people’s medicines had been checked.

Staff deployment across the service had taken staff experience and skill mix into account to meet the dependency levels of people living at the service. Although we did observe a couple of minor concerns, overall this area had greatly improved. In addition, only regular agency staff were being used and the amount had further reduced since our last inspection. The management team had been working hard to recruit the right staff in line with Barchester's values.

Group activities were regularly organised and a new activities co-ordinator was in place until further staff had been recruited. The activities team told us they were speaking with people to find out their likes and interests to ensure one to one activities and outings were more meaningful for people. Staff confirmed they were interacting with people as and when they had the time. We observed positive interactions between staff and people living at the service throughout the inspection.

Recording of one to one activities was inconsistent. Although they were more descriptive since our last inspection, some had only start times with no durations noted and for some people we were unable to see activity records being maintained. People and relatives had observed regular activities and interactions being completed by staff. This was a recording issue and the provider explained how they had focused on improving higher risk areas since our last inspection. The regional manager told us that although staff were getting better at recording one to one activities, this would be an area of focus for the management team to make further improvements.

Care plans had been reviewed since our last inspection. These were detailed and included information about people’s health conditions and guidance for staff to deliver person centred care to people.

Risks to people had been identified and managed effectively. Guidance was clear for staff to follow and included signs to look out for in relation to risks associated to people’s health conditions. Environmental risk assessments were in place and appropriate measures taken to mitigate identified risks to people.

People had been supported to have maximum choice and control of their lives. The principles of the Mental Capacity Act (MCA) 2005 were fully understood by staff and in most cases the MCA process had been followed and documented. We identified some areas where best interest decisions had been completed when there was no need and in some instances records did not show that relatives had been invited to have input in decisions made in people’s best interests.

Safeguarding concerns had been documented and managed. The correct procedures had been followed by the registered manager, issues raised by staff had been reported to CQC and when necessary the local authority.

Accidents and incidents had been recorded fully with actions taken to mitigate risks. These had been analysed and appropriate measures put in place to avoid reoccurrences.

People’s nutritional needs had been assessed and measures put in place to support them. Food and fluid charts had been fully completed and totalled to ensure issues were highlighted and addressed immediately.

People and their relatives told us they were aware of the process to make a complaint and felt confident their concerns would be addressed appropriately. Staff morale had improved since our last inspection, the staff we spoke with told us they felt confident in the leadership at the home and would not hesitate to discuss their concerns with the management team or utilise the whistle blowing process.

A dementia specialist team had been working to support the service and ensure the environment was as dementia friendly as possible.

People told us they had ample choices of food and desserts, including regular homemade snacks and refreshments available throughout the day.

Servicing and maintenance of the environment including fire safety, servicing of utilities and equipment had been completed and certified by appropriately qualified professionals. Emergency evacuation procedures were available on each unit and at the reception area of the service. Contingency plans had been reviewed and updated to include current contact details for key stakeholders.

Stamford Bridge Beaumont is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 107 people across five separate areas, during this inspection 59 people were living at the service.

There was a manager employed by the service, and they were in the process of registering with the Care Quality Commission. Following this inspection the managers application for registration had been accepted. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in September 2017 we found the provider to be in breach of eight of the Health and Social care Act 2008 (Regulated Activities) 2014 in Regulation 9 Person centred care, Regulation 10 Dignity and Respect, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 14 Meeting hydration and nutritional needs, Regulation 17 Good governance and Regulation 18 Staffing.

The overall rating for this service is ‘Requires Improvement' and therefore the service will be remaining in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found during this inspection that the provider had met the breach for Regulation 14. Improvements had been made but not sufficiently to meet the requirements of Regulations 9, 10, 11, 12, 13, 17 and 18.

We also identified one breach of the Care Quality Commission Registration Regulations 2009. This related to the failure to notify us of other events and incidents which had occurred at the service which the provider is legally required to inform us of. We will deal with the notification issue outside of this inspection process.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-led to at least requires improvement.

Care plans and risk assessments were not always aligned. There was a lack of guidance for staff around specific health conditions and how best to support people.

We saw many positive interactions between people and their relatives, but this practice was not consistent throughout the home. Some staff had little time to offer one to one interactions with people and those more isolated in their rooms had not received regular meaningful interactions.

People attended and enjoyed the group activities. The service had employed a mini bus driver to ensure regular outings in the community were arranged. However, there was a lack of stimulating activities and interactions for those people living with dementia or isolated in their bedrooms. Both staff and health professionals raised concerns around the lack of stimulation for some people living at the service.

People were not always supported to have maximum choice and control of their lives. The principles of the Mental Capacity Act (MCA) 2005 were not always fully understood by staff and the correct process for making decisions in people's best interests had not always been followed or documented appropriately.

Staff deployment across the service did not always take into account staff experience and skill mix to meet the dependency levels of people living at the service. During busy periods people did not always received the care and support they needed in a timely way. Staff were recruited safely and any gaps in support filled by agency staff, the numbers of agency staff had decreased since our last inspection during the day shifts but were still at high levels during some evening shifts. The manager told us they were focusing on this area to make improvements and had requested consistent agency staff to improve continuity for people.

Some medicines had not been managed well. We saw poor practice in the administration of one toxic medicine. As and when required medicines for pain relief were not always being monitored to ensure they were effective. Record keeping in some areas such as topical medicine charts was poor and in some cases creams had been used more than prescribed and others were unclear as to whether people had received their creams as prescribed.

Risks to people had not always been identified or managed appropriately to mitigate risks.

Staff had raised safeguarding concerns which had not been reported to the local authority or CQC.

Accidents and incidents and the actions taken were not always recorded at the time of the event happening.

Activity records were not detailed to include the time spent with people during any one to one periods and notes indicated some interactions may have been brief due to a lack of information.

People at risk of dehydration or malnutrition received an improved level of support from staff. Refreshments were seen to be given throughout the day and night to promote people's nutrition and hydration needs. Although we did see issues where fluid charts were inconsistent: they had not been totalled and no recommended amounts had been recorded. It was felt this was more of a records issue which the provider began to address during the inspection. The manager told us they had started contacting GP’s for each individual's recommended daily fluid intake to ensure improved monitoring of people's hydration.

People and their relatives knew how to make a complaint should they wish to do so. Although there were facilities for staff to raise whistle blowing concerns anonymously, despite these being in place some staff felt unable to utilise the whistle blowing procedure to raise their concerns.

The provider had numerous quality assurance systems and audits in place which identified areas that required improvements to be made. However, some of the issues found during this inspection had not been highlighted through the providers own auditing and monitoring systems. The audits lacked content and detail in some areas. For example: feedback had been gathered from relatives, people living at the service and staff, but no records reflected those that had been spoken with, the questions asked or answers obtained. During the inspection process the provider acknowledged that improvements would be made to capture this additional information.

Improvements had been made to the decoration of the premises, neutral colours had been used, spa baths introduced to create a sensory experience and near the reception a hairdressing salon and bistro type coffee area had been developed.

People enjoyed the food which looked nutritious and well presented, pureed sandwiches were available which were suitable for those with difficulty swallowing. Finger foods were also offered to people. The chef was knowledgeable about people’s dietary requirements and was aware of how to fortify diets and drinks to ensure optimum nutrition for people.

Positional changes had been completed in line with recommendations and hourly observations were being completed for all people living at the service.

Servicing and maintenance of the environment including fire safety and lifting equipment had been completed and certificates were current.

The overall rating for this service is 'Requires Improvement'.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service was meeting all regulations at our last inspection in November 2016. We had made two recommendations about responding to concerns and other issues, and the rating for that inspection was requires improvement. At this inspection we found breaches of Regulation 9 Person centred care, Regulation 10 Dignity and Respect, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 14 Meeting hydration and nutritional needs, Regulation 17 Good Governance and Regulation 18 Staffing. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager employed by the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Following the inspection we were told that the registered manager had left the service.

We found multiple failings at the service and risks to people had not been mitigated. People were not cared for appropriately. Risks to people had been identified but the written assessments did not reflect the practice of staff. Risks were not adequately managed. Accidents and incidents were not recorded consistently.

People who were at risk of dehydration and malnutrition did not always receive the level of support they needed to ensure good health. In addition positional changes for people were not carried out according to the instructions in people’s care plans putting them at risk of skin damage.

Staff were recruited safely but there were insufficient numbers of staff on duty to meet people’s needs effectively. There was a heavy reliance on agency staff who did not always know people well which put them at risk.

Some people had behaviours that challenged staff and staff were not trained appropriately. Training was not up to date and staff had not been adequately supported through supervision.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The principles of the Mental Capacity Act (MCA) 2005 were not fully understood by staff and the correct process for making best interest decisions had not been followed.

Medicines were not managed well in every area of the service. We saw poor practice by one staff when administering medicines. A community pharmacist informed us of their concerns about medicines management which included poor record keeping and missed doses of medicines.

The food we saw was nutritious. The chef was aware of how to fortify diets and provided fortified drinks and finger foods for people. However, care staff practice and supervision was poor when serving and assisting people to eat and drink.

Staff were described by people as being caring and we saw kindness shown to people by some staff. However, other staff did not always promote people's dignity or meet people's basic care needs through the care they provided.

Care plans did not always reflect the care we observed being provided by staff.

Activities were not meaningful to people living with dementia. There were no stimulating activities for people during the inspection and very few items available to stimulate people, such as books or magazines to look at.

The service had some characteristics of a dementia friendly environment but did not always reflect current good practice guidance.

Servicing and maintenance of the environment had been carried out in a timely manner.

People knew how to make a complaint but we saw that where complaints had been made they had not always dealt with in line with company policy.

There had been a lack of effective leadership and management at the service which had led to a significant deterioration in the quality of the service. This was now being addressed by the registered provider but there were still significant areas of concern.

The quality assurance system was not effective. The issues found at the inspection had not been identified through auditing and monitoring. These issues had been identified in an action plan which the provider was using to demonstrate where improvements were being made.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Stamford Bridge Beaumont is a care home which offers nursing and personal care for up to 107 people. The home is situated in Stamford Bridge, which is situated in the East Riding of Yorkshire, close to the city of York. Accommodation is provided over three floors in a Georgian listed building and purpose built extension. The home is divided into five main areas with three of these being used to support people with dementia. At the time of our inspection there were 80 people using the service.

The service is required to have a registered manager, and at the time of our inspection there was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The previous registered manager for the home had recently left, and a unit manager was fulfilling the role of ‘acting manager’ for the home, until a permanent manager was appointed. Another member of staff was also ‘acting up’ as the deputy manager for the home, whilst the appointed deputy manager was completing a six month secondment post at another home. This meant we were unable to rate the key question, 'Is the service well-led?' any higher than requires improvement.

At our last inspection in July 2015 the registered provider was not meeting legal requirements in relation to the safe management of medicines. At this inspection we found that practice had improved and the registered provider was now meeting legal requirements. Medication was appropriately stored, administered and recorded on medication administration records. Staff responsible for the administration of medication received training and any medication errors were appropriately investigated.

The registered provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. Some people, staff and relatives raised concerns about staffing consistency and staffing levels, especially at weekends and when there were staff absences at short notice. Staff told us that whilst there were always sufficient numbers of staff to meet people’s basic care needs, on some days it was difficult to find time for social interaction on a one to one basis, when there was unexpected staff absence and insufficient time to arrange replacement cover. We have made a recommendation about this in our report.

People’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm. The registered provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and concerns were appropriately reported. Staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns.

Staff completed a range of training to help them carry out their roles effectively, and there was a schedule for refreshing this training when it was required. Staff received supervision to support them in their role.

The registered provider sought consent to provide care in line with legislation and guidance. Staff had completed Mental Capacity Act (MCA) training and were able to demonstrate an understanding of the principles of the MCA.

People were supported to maintain good health and access healthcare services. We saw evidence in care files that the registered provider had supported people to access healthcare services where required, such as GPs, speech and language therapists, chiropodists and the local nurse practitioner.

Most people were satisfied with the quality of meals available and told us they got sufficient to eat and drink. Two relatives raised concerns about the availability of sufficient support for people who required assistance and encouragement with meals and drinks. We observed people being offered choice and support where required. People’s weights were monitored and action taken where people had lost weight.

The majority of people and visitors told us that the staff were kind and caring. However, some people’s comments suggested there was some inconsistency at times. We observed that on occasion the support provided by staff was functional and task focussed, but we also observed many other examples of interactions that were very warm, positive and friendly. People told us that staff respected their privacy and dignity. Support was provided to meet people’s religious and cultural needs.

The registered provider completed care plans which contained detailed information about people’s needs and preferences; these were regularly reviewed by staff to ensure they reflected people’s current needs. Most staff were also able to demonstrate a good understanding of people’s needs and preferences. The registered provider employed activities co-ordinators and there was a range of leisure and social activities available to people.

There was a complaints procedure in place and records were held of formal complaints that had been raised and addressed. However, we found that some people had raised concerns informally and did not feel these had been resolved to their satisfaction. Not all people we spoke with told us they would feel comfortable raising concerns. Opportunities to encourage people to give their views, in resident’s and relative’s meetings for instance, had not been consistently available across the home. We have made a recommendation about this in our report.

There was a quality assurance system in place, which included the completion of a range of regular audits. This enabled the registered provider to identify issues and measure the delivery of care. Whilst most issues identified in audits were addressed, we saw some examples where action had not been taken promptly.

All of the observations we made throughout our visit were positive. We found that staff worked hard to provide effective, safe and appropriate care. However, we found that some staff needed to revisit the principles of person-centred care and use of language in their record keeping to make sure that care provided was non-discriminatory, positive and tailored to the individual's ability.

People who used the service were cared for in a warm, comfortable and clean environment that was well maintained.

Overall, we found that effective management systems were in place to promote people's safety and wellbeing.